197610184-9-6-2024-31-AS-ADUA-D8URMS-20240906130913

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610184
Report Date: 09/06/2024
Date Signed: 09/06/2024 01:09:21 PM

Document Has Been Signed on 09/06/2024 01:09 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	OAKMONT OF SANTA CLARITA		FACILITY NUMBER:	197610184
ADMINISTRATOR:	PARK, TOM		FACILITY TYPE:	740
ADDRESS:	28650 NEWHALL RANCH ROAD		TELEPHONE:	(661) 295-2025
CITY:	SANTA CLARITA	STATE: CA	ZIP CODE:	91355
CAPACITY:	121	CENSUS: 99	DATE:	09/06/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Tom Park, Executive Director		TIME COMPLETED:	04:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Abeye Duguma met with the Executive Director, Tom Park, for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 9:00 AM and the following was noted: There is one entrance being utilized at the facility. The facility consists of eighty-six (86) rooms. The rooms consists of single or shared occupancy. A random selection of bedrooms was toured both in Memory Care and Assisted Living. All bedrooms were properly furnished and had appropriate bed linens. The rooms were observed to be sanitary. The bathrooms were toured and observed to be clean and properly stocked with towels and soap. Nonskid mats and grab bars were observed in all bathrooms. The facility is fire cleared for one hundred twenty-one (121) non-ambulatory, of which eight (08) may be bedridden, and a hospice waiver for fifteen (15). The facility is currently occupying ninety-nine (99) residents. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool. Laundry detergents, cleaning agents and other toxins are locked away. Kitchen is sufficiently stocked with at least two (02) days perishable and seven (07) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. (continued on LIC 809-C)

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: OAKMONT OF SANTA CLARITA	FACILITY NUMBER: 197610184
	VISIT DATE: 09/06/2024

NARRATIVE

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The living and dining room are neat and clean. The facility maintains a comfortable temperature at 76°F. The smoke and carbon monoxide detectors are hardwired, interconnected and inspected periodically. The fire alarms are programmed to dispatch the local fire department. Fire extinguishers are located throughout the facility, observed to be fully charged and last inspected on 01/12/2024.

The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The average hot water temperature was measured at 117.4°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets.

LPA observed medication to be locked and inaccessible to residents. Facility maintains a complete first aid kit.

No health and safety hazards noted during the visit.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024

LIC809 (FAS) - (06/04)

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